Management of Minor Traumatic Brain Injury in an ED Observation Unit

Matthew A. Wheatley, MD; Shikha Kapil, MD; Amanda Lewis, MSSc, PA-C; Jessica Walsh O'Sullivan, MD; Joshua Armentrout, MD; Tim P. Moran, PhD; Anwar Osborne, MD, MPM; Brooks L. Moore, MD; Bryan Morse, MD; Peter Rhee, MD; Faiz Ahmad, MD; Hany Atallah, MD


Western J Emerg Med. 2021;22(4):943-950. 

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There are many limitations to this study given its single-center, retrospective design. A large, multicenter RCT is needed to better understand the true relationship between EDOU care and LOS. In addition, because adverse outcomes in BIG 1 and 2 class TIH are rare, larger numbers are needed to truly understand the safety of this approach. However, because TIH patient are a high-risk population a more precise understanding of the rates of hemorrhage progression and need for emergent neurosurgical intervention is essential before EDOU care can be widely recommended.

The biggest limitation of this study is the limited follow-up information in the intervention group. Because this study began as a quality improvement initiative, there initially was not a robust mechanism to conduct follow-up interviews to investigate whether patients were still experiencing symptoms or had repeated medical visits due to their injuries. This is an important area for future study. Patients were chosen for the EDOU based on clinician gestalt that the patient fit within the inclusion/exclusion guidelines. This could introduce bias into the results as patients who were thought to be sicker or more complicated were likely admitted to inpatient units. The control group for this study is small and thus may limit the strength of association of some of the outcomes. This study was conducted in an urban teaching facility and Level 1 trauma center; thus, it may not be translatable to smaller or rural centers without trauma or neurosurgical services. Further studies involving non-Level I trauma centers are necessary.